DALLAS — At the 20th EMS State of the Science, a Gathering of Eagles Conference, RJ Frascone, medical director for Regions Hospital EMS in Minnesota asked the audience whether or not it’s important to intubate kids, particularly those that are not in cardiac arrest.
Frascone discussed his agency’s experiences involving pediatric intubation as the organization switched from direct laryngoscope to video laryngoscope. He also challenged the audience, noting it is time for another pediatric intubation trial.
Memorable quotes on pediatric intubation
Here are some memorable quotes on pediatric airway management from Frascone’s presentation:
“I think I performed the first pediatric video laryngoscope trial.”
“Where [video scopes] really shine is when the airway is difficult, and frankly, there just aren’t that many difficult airways out there for experienced providers.”
“I think everybody that uses video scopes just knows inherently that they are superior to direct scopes, but it hasn’t really come out in the literature.”
“Providers who are really struggling – it’s like a hot knife through butter once they get the video scope in their hands.”
Key takeaways on pediatric intubation
Frascone left attendees with the following key takeaways on pediatric intubation:
1. Frascone’s data shows no difference between direct and video laryngoscope
Although it was a small study, with 28 direct laryngoscope intubations before and 27 video laryngoscope intubations after the change, there was no difference in first-pass success rate for pediatric patients. The one caveat to this observation was the prevalence of more difficult airways in the video laryngoscope group, something that was defined prior to the start of the trial. This suggests that providers may be more willing to intubate these patients when assisted by video technology.
2. King Vision Study shows role video laryngoscope can play
In a 2015 study published in Prehospital Emergency Care, one suburban agency showed significant improvements after mandatory video laryngoscope was implemented system-wide. An important distinction with this study was the low first-pass success rate during the use of direct laryngoscopy. Therefore, it’s hard to definitively argue that the improved results were entirely due to the switch to video laryngoscope.
3. It’s time to study pediatric intubations using new technologies
One of the best known research articles on pediatric intubation was published in JAMA in February 2000 using data collected from 1994 to 1997. It was well-done study, however, it was performed prior to the widespread use of capnography and video laryngoscopy. As such, it’s possible the results would change if these two concepts were included in the comparison groups.
Additional resources on pediatric airway management
Here are EMS1 articles and quizzes to learn more about pediatric airway management:
- 3 ways to avoid making critical pediatric airway errors
- Pediatric IO: 5 things I didn’t learn in paramedic school
- Prove it: Video laryngoscope usage in airway management
- What I learned from managing pediatric airway emergencies
- 5 tips for securing a patient’s airway
- Pediatric patient ABCs: 7 tips for EMTs and paramedics
- A guide to pediatric vital signs
- 3 steps to improve pediatric cardiac arrest outcomes
- What Would You Do? Baby who turned blue is now fine
- Controversies in the paramedic management of the pediatric airway
